| NPI | 1114025970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 8674) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PR 2275) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2017-12-12 |